Including mental health among the new sustainable development goals.

The United Nations will soon decide what will follow its millennium development goals, which expire in 2015. The case for including mental health among the new sustainable development goals is compelling, both because it cuts across most of the suggested new goals and because of the unmet needs of the 450 million people in the world with mental illness. Poorer mental health is a precursor to reduced resilience to conflict. It’s also a barrier to achieving the suggested goal of promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, and building effective, accountable, and inclusive institutions at all levels. In addition, conflict is itself a risk factor for adverse mental health consequences, and in the aftermath of conflict the needs of vulnerable groups such as people with mental illness are often accorded the lowest priority (as documented by photojournalist Robin Hammond, www.robinhammond.co.uk). The improvement of mental health systems will also have a decisive role in making cities and human settlements inclusive, safe, resilient, and sustainable, and this is especially important given the global trend towards urbanisation with its associated risk factors for mental illness. Moreover, individual adversity—for example, complications of pregnancy, such as miscarriage—is associated with worse mental health. A third suggested goal is to promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all. People with mental illness have far lower rates of employment than the rest of the population, and periods of economic recession are related to worse mental health in the population, especially among men. More generally, people with untreated mental disorders have a negative effect on global wealth because they increase school and work absenteeism and dropout rates, healthcare spending, and unemployment rates. Disregarding the needs of the population for mental healthcare impairs productivity, costing the world in excess of $16tr (£9.5tr; €12tr) a year in lost economic output. In order to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, we will have to recognise that mental health problems, especially developmental disorders such as attention-deficit/hyperactivity disorder, are often associated with educational underachievement and that these blight long term economic prospects. Moreover, educational stressors are risk factors for suicidality among school and college students. Mental health is also relevant to the goal of ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture. Mental illness in mothers is a risk factor for child undernutrition, and poor diet among people with severe mental illness contributes to their worse physical health. Ensuring healthy lives and promoting wellbeing for all at all ages is also impossible without a consideration of mental health. Inequality within and among countries cannot be fully addressed unless we recognise that nearly a quarter of the world population—the number who experience a mental illness each year—experience systematic discrimination in most areas of life. Indeed, the right to health, as incorporated in the United Nations Convention on the Rights of Persons with Disabilities, is manifestly neglected as the life expectancy among people with mental illness is up to 20 years lower among men and 15 years lower among women than among their counterparts without mental illness. People with severe infections (such as HIV/AIDS) or non-communicable diseases also show premature mortality if their adherence to medication is compromised by undetected or untreated coexisting mental illness. The fundamental point is that health must include mental health, as defined by WHO and accepted by all nations, not just in spirit but in reality.